St. Joseph County Health Officer, Robert Einterz, MD, issued a Public Health Order Sunday night.
(Read more from Einterz's order below.)
Locally, our data and public health indicators suggest on-going community transmission of SARS-CoV-2, the virus that causes the disease referred to as COVID 19. The intent of this Health Order is to protect the health and safety of the residents of SJC from the morbidity and mortality caused by SARS-CoV-2. lt is anticipated that this order will remain in effect until such time as the level of immunity within the population is estimated to reach 70% of the population as determined by serological testing of a representative sample of the population of the county. The following is hereby ordered to be in effect:
Any business establishment open to customers shall make alcohol-based hand sanitizer that contains at least 60% alcohol readily accessible at the entrance and in proximity to hightouch surfaces.
A face covering over one's nose and mouth shall be required for any persons entering an enclosed public space or place of business, unless such persons have a medical exception indicating that a face covering is ill-advised for health reasons, or the face covering prevents the persons from delivering or receiving services. The face covering shall be worn at all times when physical distancing of at least six feet cannot be maintained.
In addition, the health officer issued a separate letter to leaders of St. Joe County, Mishawaka and South Bend.
(The letter is below.)
To: Commissioner Andrew Kostielney, Mayor James Mueller, Mayor Dave Wood
From: Robert M. Einterz, MD and Mark D. Fox, MD, PhD, MPH
Over the last week, in anticipation of the Governor’s announcement regarding the status of his Stay-at-Home order, the St. Joseph County Unified Command engaged in vigorous discussion regarding what our response should be, depending on whatever position the Governor would espouse. The purpose of this memo is to summarize the discussion and conclusions from Unified Command, as well as to articulate additional requirements that the St. Joseph County Department of Health is proposing as we move forward.
We have maintained that the criteria to warrant any relaxation in restriction should be:
1. Consistent decrease in the number of new cases
2. Sufficient hospital capacity to accommodate COVID admissions, as well as other admissions
3. Access to testing, testing supplies, and personal protective equipment (PPE)
4. Sufficient capacity for contact tracing
While there continues to be day-to-day variability in the number of new cases, the trend has been decreasing or stable over the last 12 days. [NB: There is some artifact attributed to decreased access to testing on weekends and re-emerging delays in test reporting; nevertheless, we feel reporting of results is reasonably complete through 4/29/20, thus our observations are focused on the 12-day period 4/18/20-4/29/20.]
We have been monitoring Adult Bed Capacity in SJC Acute Care Hospitals, Ventilators Available, as well as the hospital censuses of COVID+ patients and Persons Under Investigation for COVID (PUIs). While the overall COVID+/PUI census has increased over the last 10 days (from 45 to 66), some of this increased utilization is attributed to difficulty in placing patients in nursing homes, as they require two negative tests for COVID for placement; this requirement is reasonable, but contributes to extended hospital stays and increased census. While these extended stays place some burden on PPE supplies, that burden will exist regardless of setting as long as patients are testing positive for the virus.
The key point is that the increased census does not necessarily translate to increasing high acuity burden of COVID in the community at this time. One concern has been the resumption of diagnostic and therapeutic procedures for other conditions (which have been on hold except for time-sensitive interventions) and the burden these may create with respect to bed capacity and PPE. The clinical systems represented in Unified Command have felt comfortable with their ability to accommodate increased clinical activity, as well as the potential for increased public interaction associated with a relaxation of the Stay-at-Home order.
Obviously there has been considerable discussion locally and nationally regarding access to testing, and there continue to be concerns locally related to the adequacy of testing supplies.
The addition of a state-funded testing site in South Bend (anticipated in the next week) will increase capacity somewhat; however, the view of Unified Command is that local clinical systems have expanded access to testing and have adequate supplies and personnel to pursue testing based on clinical judgement without imposing a restricted decision-making algorithm. Thus, the state’s testing site augments testing capacity but its operational implementation isn’t a necessary prerequisite for relaxing restrictions. There remains considerable concern within Unified Command regarding how local employers will access testing for employees with the inevitable diagnosis of COVID-19 among one or more of their employees.
In a similar vein, the launch of the state’s contact tracing may shift some burden from the local health department, we feel that we are managing the current workload and will have the capacity to continue to meet the demand pending implementation of the centralized contact tracing mechanism.
We recognize that the progress that has been made with regard to the spread of COVID-19 in our community is attributable to the mitigation strategies that have been pursued to date. However, the consensus of Unified Command is that we are well-positioned with respect to the criteria outlined that it was not necessary to attempt to impose a continued Stay-at-Home order for St. Joseph County.
Instead our focus has been on how to continue to reinforce the threat of COVID-19 in our community and the importance of continuing mitigation strategies. Additionally, we propose, under the authority granted the Health Officer in the Indiana Code, to impose the following additional requirements for St. Joseph County:
1) Any business establishment open to customers shall make hand sanitizer readily accessible at the entrance and in proximity to high-touch surfaces.
2) A facemask or face covering shall be required for any persons entering an enclosed public space or place of business, unless such persons have a medical exception indicating that a face covering is ill-advised for health reasons. The facemask or face covering shall be worn at all times when physical distancing of at least 6 feet cannot be maintained.
The provisions will remain in effect until at least July 4, 2020, but may be extended until such time as the level of immunity within the population is estimated to reach 70% of the population as determined by serological testing of a representative sample of the population of the county.
The Department of Health will monitor commercial enterprises and impose abatement orders in response to these requirements. In addition, the Health Officer may pursue formal Isolation and Quarantine orders for infected individuals and close contacts identified as not complying with clinical recommendations.